Annotated Bibliography on Nursing Informatics

Al-Hawamdih,S. & Ahmad, M. (2018). Examining the Relationship Between Nursing Informatics Competency and the Quality of Information Processing. Computers, Informatics, Nursing: CIN, 36(3), 154-159. doi: 10.1097/CIN.0000000000000379.

Aim of the Article and Main Findings

The purpose of this study is to look at nursing informatics and the quality of information processing for nurses in Jordan.  The study was conducted in a large hospital consisting of 400 beds and 1200 employees, with 380 registered nurses.  The convenience sample had a total of 99 nurses that used the electronic health record (EHR) for 3 months.  Inclusion criteria for the nurses included bedside nurses that were willing to participate and had used the EHR system for 3 months.  The study was conducted using a four-part questionnaire that assessed personal and job characteristics, Self-Efficacy, Self-Assessment Nursing Informatics Competency Scale, and a Health Information System Monitoring questionnaire.  The results of the study showed that there was a correlation between Nursing Informatics competency and the quality of information processing.  The results support the need for more training and education of nurses in the field of nursing informatics.

Strengths and Weaknesses of the Article

The strengths of this study are that it provides many implications for nurse leaders in practice.  The study focuses on advancing the nursing career and the importance of informatics in the restructuring of health care, which is also a strength of the study.  Another strength of this study is that they found a statistically significant correlation between quality of information processing and NI competency and clinical informatics attitude with r=0.34, P< .01, and r= 0.32, P< .01 respectively.  There were an equal number of males and females used in the study, which is also a strength. One weakness of this study is that a sample size of 99 people is small.  Another weakness of this study is that the nurses in the study had an average age of 28, meaning that the results only represented a specific age group. The majority of the nurses had a BSN, with only 9% having an MSN, this does not give an equal representation, which is also a weakness of the study.  Another weakness of this article is that it used self-report measure of competency that gives subjective data that will vary from person to person.

Evaluation/Opinion of the Article

Overall, the findings of this study have valuable implications for nursing practice.  The study is well organized and the purpose is clearly indicated to the reader.  Including charts within the study provides good visualization to the reader, and makes the information easier to comprehend. The study would have been more informative if it had provided the reader with the components of the four-part questionnaire.  Although the questionnaires were discussed, there were no details regarding the actual questions within the surveys.  Also, including information on past or current studies that are similar would allow for comparison and contrast and make the results more reliable. Also, including a more diverse and larger sample size would have been beneficial for the study.

Brazelton, N., Knuckles, M., & Lyons, A. (2017). Clinical Documentation Improvement and Nursing Informatics. Computers, Informatics, Nursing, 35(6), 271-277 doi: 10.1097/CIN.0000000000000367

Aim of the Article and Main Findings

The purpose of this article is to discuss the benefits of clinical documentation improvement programs.  These programs are widely implemented and provide an opportunity for nurse informaticists to work together to optimize the patient’s health record, the electronic health record system (EHR), as well as make progress for standardizing language and vocabulary that is used to communicate with patients.  The article also discusses the importance of clinical documentation improvement (CDI) nurses and their role as educators and facilitators.  The article goes on to discuss the importance of CDI nurses and nurse informaticists communication with each other and bringing beneficial change to patients through collaborative efforts. 

Strengths and Weaknesses of the Article

One strength of this article is that multiple examples of the queries used by CDI’s are detailed in a figure, allowing the reader to visualize and understand the components of the query and its applicability.  Another strength of the article is that it outlines the many potential benefits and excepted results from collaboration of coders and CDI nurses. One more strength of this article is that the overall focus is on improving patient care. The authors of this article are all advanced practice nurses with a background and understanding for the importance of nursing informatics, which is also a strength.  One weakness of this article is that the role and description of  “coders” is missing.  Providing a brief description of their role would help the reader understand the goals of the topic better.  Another weakness of this article is that although the importance of CDI nurses and nurse informaticists collaborating is discussed, providing an example of why this would be beneficial as well as how they can collaborate to implement change would have made the article stronger.

Evaluation/Opinion of the Article

The purpose of this article is clearly defined, and the article supports this purpose.  The article is well organized and provides examples throughout, making it easy to follow for the reader.  The article brings up a good point regarding clinic and hospital nurses lack of experience with provider billing.  From personal experience, transitioning from the role of a registered nurse to family nurse practitioner, there is a knowledge deficient and lack of experience with billing. The use of CDI nurses to educate nurses regarding billing and coding will help make the EHR more functional. Overall this article is interesting and informative and related to the field of nursing throughout, whether it is for RN’s or NP’s the results are applicable to a variety of settings. 

Carrington, J., Dudding, K., Estrada, N., Finley, B., Nibbelink, C., Rasmussen, R.,…Tiase, V. (2016). Nursing Informatics Research and Emerging Trends in 2015. Computers, Informatics, Nursing, 34 (1),284-286. doi: 10.1097/CIN.0000000000000278.

Aim of the Article and Main Findings

The purpose of this article is to give an overview of all of the advancements that have been made in the field of informatics in the year 2015.  It reports findings from a literature review of nursing informatics research and highlights recommended articles.  By doing so, the authors were able to identify common themes and topics, quantify the number of nursing informatics research papers, and solicit influential work from nursing informatics colleagues.  A total of 38 articles were used for the literature review, after a two search method was conducted.  The majority of the articles that were used were found from PubMed. The most common setting for nursing informatics was acute care, and the most common area of research was electronic health record systems.  Education, was the second most searched research topic.   Public health, community setting and mobile e-Health-focused research was also identified as being an emerging field of study.

Strengths and Weaknesses of the Article

There are many strengths and weaknesses of this article.  One strength is that a diverse range of articles was used for the literature review.  Articles ranged from acute care, long-term care, home, operating room, healthcare organizations, literature and simulation laboratories.  Another strength is that the articles studied were within a one-year span, and therefore only the most current literature was reviewed.  One weakness of this article is that not all work in the field of nursing informatics was used for the review, and therefore there are major topics that may have been eliminated just based on the search criteria that was used. The search criteria also limited the articles to those with an RN being the first author. This is also a weakness because it eliminates other articles on which nurses may have collaborated on with out being the first author.

Evaluation/Opinion of the Article

This article was well thought out and organized.  The information is relevant to the current time and reflects recent research in the field of nursing informatics.  The research methods are clearly identified, giving the reader a clear understanding of the process taken for the literature review.  However, including more than 38 articles by broadening the search terms would have increased the range of articles used and given a better overview of the current topics in nursing informatics.  The article also provides a few examples of key studies that were used in the literature review allowing the reader to have a reference for what the articles discussed.  Overall this article was very informative and gave insight into the current trends and themes in nursing informatics.  Discussing topics that weren’t found to be major topics of interest, but that need to be addressed would have given insight into how future research can be improved in this field.

Collins, S., Kennedy, M., Phillips, A. & Yen, P. (2017). Nursing Informatics Competency

Assessment for the Nurse Leader, The Delphi Study. The Journal of Nursing Administration,47(4), 212-218. doi: 10.1097/NNA.0000000000000467

Aim of the Article and Main Findings

The primary goal of this study was to identify which nursing informatics competencies are relevant and necessary for nurse leaders to have.  The motivation for this study came from identifying significant nursing informatics deficits. Many times IT decisions are left to others because nursing leaders don’t have the needed knowledge and experience. This impedes the nurse leaders ability to continue to innovate, and advance new models of health care delivery.  This study was conducted with an environmental scan and 3-round survey using Delphi methods used with nurse leaders to identify competencies.  The environmental scan identified existing nurse leader informatics competencies.  The study revealed that most nurse leaders learned informatics competencies through on the job training, and a total of 74 competencies were identified.  The study can lead to a more competency-based model of nursing informatics.

Strengths and Weaknesses of the Article

One strength of this study is that it addresses 108 competencies for nursing informatics and identifies them as being important and urgent needs within the field of nursing informatics.  Having such a broad variety of competencies that are addressed allows for the data to be applicable to variety of settings and nursing leaders, which is another strength of the article.  A weakness of this article is that the results are only limited to those that chose to take this survey, indicating that they already had an interest in nursing informatics.  The data is not representative of those nursing leaders that have no past interest or knowledge regarding nursing informatics.  Another weakness of this article is that due to the snowball sampling method that was used in this study, they were unable to report a response rate.

Evaluation/Opinion of the Article

This article is well written, organized and easy to comprehend for readers that have no previous knowledge regarding nursing informatics.  The study clearly states the purpose, which is to identify the competencies nurse leaders feel are relevant to their practice.  The study follows through with the over-all purpose of the article. The findings of the article are relevant to the field of nursing and informatics and the results are valuable to the field of nursing.  With the constantly evolving field of informatics, this article brings to attention that there is a knowledge gap regarding informatics within the nursing profession.  Nursing professionals are quick to rely on information technology professionals, which impedes the progress of the profession.  Implementation of more comprehensive informatics education can help nursing professionals feel more confident with using EHRs.  The article would have been stronger if it included specific information regarding methods to enforce comprehensive informatics education. 

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Cosansu, G., DeBlieck, C., Eardley, D., Garner, L., Krumwiede, K., Nahcivan, N. & Secginli, S. (2018).  The Omaha System as a Structured Instrument for Bridging Nursing Informatics With Public Health Nursing Education: A Feasibility Study. Computers, Informatics, Nursing, 36(6), 275-283. doi: 10.1097/CIN.0000000000000425

Aim of the Article and Main Findings

The goal of this study is to address the need for adopting health information technology to maintain healthcare quality.  A case study that was developed by nursing professionals for use in undergraduate level public health nursing courses is used as an example for health information technology in this study. The research question asks if a public health nursing (PHN) case study mapped to the Omaha system is an effective tool for teaching students proper use of electronic health record (EHR) charting.  A descriptive case study with a convenience sample of 72 nursing students enrolled in PHN courses was used for this study.  The results of the study indicated that the case study mapped to the OMAHA system was an effective instrument for teaching EHR charting and the PHN process for population health. 

Strengths and Weaknesses of the Article

One strength of this study is that a large range of researchers from international and national borders collaborated with the use of virtual environments.  Another strength of this study is that the case study was similar to real life scenarios and is therefore applicable. The main strength of this article is that the results were statistically significant, indicating that the students met the learning objectives and skill development with EHR charting.   One weakness of this study is that there was no control group used. The use of a control group would help validate the results.  Another weakness is that a small purposive sample size was used.  Also, there was an online as well as classroom teaching system used and these differences should have been considered in the evaluation.

Evaluation/Opinion of the Article

This study addresses the need for nursing informatics for nursing students, which is relevant to healthcare today.  There are so many movements towards integrating informatics into the nursing education at all levels.  This article presents a structured study that effectively addresses the use of a case study to educate students on EHR management.  The use of a case study made the study easy to follow for the reader.  It also allowed the reader to see how similar studies can be replicated using these methods.  The students used for this study were from four different schools. Using a larger number of schools would have validated the results even more.  Also, providing a control group would help gauge the level of education improvement in comparison to an intervention group.  Overall the finds of this study can be used in different academic settings, and provide a framework for teaching nursing informatics in various school settings.  

Kassam, I., Nagle, L., & Strudwik, G. (2017). Informatics competencies for nurse leaders: protocol for a scoping review. BMJ Open, 7(12), e018855. doi: 10.1136/bmjopen-2017-018855

Aim of the Article and Main Findings

This article aims to utilize a scoping review in order to identify informatics competencies that are applicable for nurse leaders.  This scoping review aimed to: identify informatics competencies of relevance to nurse leaders, identify frameworks or theories that have been used to develop informatics competencies for nurse leaders, identify instruments used to assess the informatics competencies of nurse leaders and examine the psychometric properties of identified instruments.  This study used the Arksey and O’Malley five-step framework and included two primary and five secondary databases.  A dissemination of the findings from this study will be done to target particular audiences.  The results will be used to informed future studies focused on the same topic.

Strengths and Weaknesses of the Article

One strength of this article is that it is the first literature review that will consolidate nursing informatics competencies for nurse leaders.  Also, the search strategy for this review was developed in collaboration with a research librarian that was experienced with research databases.  Another strength, is that two primary databases: the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medline (OVID interface), and five secondary electronic databases were used.  The researchers will review the first 100 citations from each source, ensuring the quality and relevance of the citations.  One weakness of this study is that although the purpose also states that globally, health informatics is being used, only studies and documents published in English were used.  Using more diverse studies would allow the findings to be applicable to a more global population.  Another weakness of this study is that the studies used were only those that are directed to nursing leaders, defined as nurses that are not providing direct care to patients.  However, bedside nurses are still nurse leaders, and also greatly utilize nursing informatics, and would benefit from these studies as well. 

Evaluation/Opinion of the Article

This article is well thought out and organized.  The methods clearly indicate a step-by-step analysis of how the scoping review will be conducted.  The article also clearly identifies the search strategy that will be used to search for studies that will be used for the review.  The article also discusses how the review will benefit health care institutions and nursing leadership organizations.  One criticism for this article is that providing an example of the chart that will be used for analysis of the data, and more information regarding how the analysis of the data will be calculated should be included.  Providing a case study would have allowed the reader to apply the information discussed in the article.

Kelly, J., Spurlock, A. & Vardaman, S. (2017). Patient Safety Addressed Through Reconciliations. Computers, Informatics, Nursing 35(7), 325-328. doi: 10.1097/CIN.000000000000037.1

Aim of the Article and Main Findings

The purpose of this article is to provide a solution for medication errors that arise with patients admitted to the hospital. This article addresses the issue of polypharmacy amongst the elderly population and how medication reconciliation can positively affect patient outcomes. The main finding of this article is that the use of clinical reminders (CRs) created with hospital information technology departments within the electronic health record can improve medication reconciliation by almost 30%.  Therefore, CRs are a cost-effective way to improve patient outcomes.  A CR was identified as a cue that an event that needed to occur had not happened.  The results of the study showed that there was an increase in medication reconciliation post CR use.

Strengths and Weaknesses of the Article

One strength of this article is that it provides several examples of how CR programs in a variety of settings have yielded positive patient outcomes.  For example, the use of CRs in anesthesia led to more timely administration of antibiotics from 69% to 92%. A weakness of this study is that the number of charts used was small, and having a larger number would have resulted in more statistically significant data.  Another weakness is that the data was collected in the fall time when influenza was widespread. This seasonal variation could have impacted the results of the study.  Another weakness is that many nurses argued that computer issues associated with CR would negatively effect patient care time, and this issue was not addressed. 

Evaluation/Opinion of the Article

This study not only addresses the main purpose of the article, but also provides examples of similar studies that have also yielded similar results.  Medication errors are a huge cause of concern, and nurses are at the front line of preventing these errors from occurring. This is an issue that nurses at all levels face on a regular basis. This study provides a solution to reduce the number of medication errors, and improve patient outcomes for patients admitting the healthcare facilities.  Studies like this lay the foundation for continued development of information technology and its’ use in reducing errors and improving patient outcomes.  One criticism for this article is that it does not mention methods for training nurses to use the CRs in EHRs.  Having a training protocol could potentially reduce computer system issues that delay patient care.

Vottero, B. (2017), Teaching Informatics to Prelicensure, RN-BSN, and Graduate Level Students. Nurse Educator 42(55) S22-S26 doi:10.1097/NNE.0000000000000414.

Aim of the Article and Main Findings

The goal of this article is to discuss the importance of nursing informatics education for undergraduate and graduate nursing programs.  The purpose of this article is to also discuss how nursing informatics should be incorporated into these education programs.  Dedicating 1-3 weeks for foundational concepts in informatics courses during all nursing programs can help level students’ knowledge for the remaining course.  The article identifies the main aspects of informatics that should be taught, as: Basic Computer Competencies, Information Management, Patient Care Technologies, Clinical Information Systems, and Decision-Making Supports.  As nursing informatics continues to shape health care delivery, it is vital to deliberately incorporate nursing informatics into the nursing education curriculum.   

Strengths and Weaknesses of the Article

A strength of this article, is that all of the different educational needs are addressed in detail.  In addition to identifying all of the key components that must be addressed in these educational programs, the author further gives examples that are applicable at the prelicensure, RN, and graduate level.  One weakness of this article is that these educational guidelines may not be applicable in this format for all types of education systems.  It should take into consideration how the framework would work for online programs, accelerated BSN programs, or programs that are direct RN-BSN.  The guidelines and format would need to be adjusted to meet the needs of these programs that are not traditional RN, BSN, or graduate level programs. Another weakness is that past studies with statistical evidence are not provided.  Seeing the results of similar studies that have implemented such educational programs would provide a reference for ways to improve or maintain the current framework.

Evaluation/Opinion of the Article

This article is well thought out and relevant to the field of nursing today.  The importance of incorporating informatics into nursing education is integral for the development of healthcare and for more efficient patient care. The field of nursing is constantly evolving and nurses must be properly educated in order to grow and keep up with the changing field.  On the job informatics training is no longer sufficient, and prior knowledge and skills will help nurses feel more confident and independent in the work place.  One criticism for this article however is that the incorporation of past studies in which such educational framework has yielded positive outcomes would have made the goal more convincing.

Watts, C.S. (2016). Preparing Nursing Graduates for the Future: Adding Informatics Education To Entry Level Programs. Nursing Informatics Today, 31(1), 10-16

Aim of the Article and Main Findings

The purpose of this study is to discuss a project that was developed to add informatics education at the bachelors and associates level of nursing education at a rural community college in southern Ohio. With the passing of the Affordable Care Act (ACA), there is more emphasis placed on the use of technology to meet health care goals and ensure that nurses have the knowledge and skills to handle these technological advances.  By developing a course for nursing’s graduates, the knowledge gap is addressed. The project was successful at incorporating and introducing a nursing informatics course into the curriculum.  The learning needs of the students were assessed by first conducting an initial assessment of the level of computer literacy.  Stake holders in the project included previous students that have already graduated.  The project was successful in adding informatics into the system.

Strengths and Weaknesses of the Article

The strength of this article is that it is well thought out and organized and includes a clear purpose.  Another strength of the article is that it includes a self-assessment tool used for the student in order to determine the individual learning needs. It also gives a clear picture of all of the various components that must be included in a course. There are also weaknesses to this article.  The article failed to discuss the specific components of the course or how long the duration of the course would be. Another limitation of the article is that it only discusses the steps for adding this course for a small community college. The methods and results obtained may not work for a larger school with a different budget and resources. 

Evaluation/Opinion of the Article

The purpose and aim of the article was easy to follow. However, details regarding the length and time of the course are missing.  Also, the article does not address who would have the power and ability to allow for the course to be added to the curriculum. The individual scoring system allows for individualized feed back for the student, however the curriculum is the same for all students.  This does not seem fair, since students are at differing levels of competency, and therefore course requirements should also be individualized. Overall, this article provides detailed information that could be replicated at other schools in order to decrease the knowledge gap that many nurses have. 

Wilburn, A. (2018). Nursing Informatics: Ethical Considerations for Adopting Electronic Records. NASN School Nurse, 33(3), 150-153. doi:10.1177/1942602X17712020

Aim of the Article and Main Findings

This article focuses on the ethical issues surrounding nursing informatics in a school setting. Many schools across the country are now adopting electronic health record systems, and it is the nurse’s responsibility to ensure that the privacy of the students remains protected. This article specifically discusses a case study at ABC school district and the ethical issues surrounding the implementation of a new cumulative records system.  The options for a new system are presented to a nurse leader. In addition to issues related to the financial burden of such a system, the nurse must also investigate ethical issues such as compliance with the Health Insurance Portability and Accountability Act (HIPPA) and the Family Educational Rights and Privacy Act (FERPA). A big issue that the nurse must address is how to ensure confidentiality and privacy with an electronic health system.  The findings of the study suggested that the nurse must take into account various factors such as speaking to the state school nurse consultant as well as the school district legal team.  According to the article, another recommendation for the nurse is to encourage the school district to be transparent with parents and stakeholders as to what information can and cannot be released.  School nurses must consider all of these ethical issues surrounding implementation of electronic health record systems in the school setting. 

Strengths and Weaknesses of the Article

A strength of this article is that it not only discusses an issue that is very relevant to the field of nursing, but that it also provides a case study.  This allows the reader to follow a real example, and apply all of the issues to a real life setting.  Another strength of this article is that it is organized by the different ethical and legal issues presented.  This organization allows the reader to clearly understand the issues that are being discussed.  One weakness of this article, is that there is only one case study that is presented.  Therefore there is only one perspective that is presented, and the results and discussion are limited.  Having multiple nurses, school districts, and different types of school settings would have given a more broad understanding and discussion of the issue.  Another weakness of this article is that it presents a hypothetical case study, which discusses what the nurse can and should do.  It does not however discuss a situation that has already occurred.  Presenting information that has already happened would give the reader insight into future changes that can be made to correct the issues that are already occurring. 

Evaluation/Opinion of the Article

Overall, this article discusses an issue that is very applicable to the changes that are occurring across the country with advancements in informatics in the health care setting.  Although the issues presented in this article focus on the school setting, the ethical dilemmas presented are applicable to other settings such as hospitals, clinics, etc. as well.  This article does a good job of explaining the issue at hand.  However, providing different examples of different types of school settings such as private vs. public schools could have made a difference with the results and discussion.  Also, although the various ethical issues are fully discussed in the article, there is not much discussion regarding the pros and cons of having an electronic health record system.  Providing concrete evidence of the benefits by providing past examples would have been beneficial.  Also, providing examples and statistical data regarding the number of identities that have been compromised in the past would also have made the points discussed in the article, stronger.

References

•                                                     Al-Hawamdih,S. & Ahmad, M. (2018). Examining the Relationship Between Nursing Informatics Competency and the Quality of Information Processing. Computers, Informatics, Nursing: CIN, 36(3), 154-159. doi: 10.1097/CIN.0000000000000379.
•                                                     Brazelton, N., Knuckles, M., & Lyons, A. (2017). Clinical Documentation Improvement and Nursing Informatics. Computers, Informatics, Nursing, 35(6), 271-277 doi: 10.1097/CIN.0000000000000367
•                                                     Carrington, J., Dudding, K., Estrada, N., Finley, B., Nibbelink, C., Rasmussen, R.,…Tiase, V. (2016). Nursing Informatics Research and Emerging Trends in 2015. Computers, Informatics, Nursing, 34 (1),284-286. doi: 10.1097/CIN.0000000000000278.
•                                                     Collins, S., Kennedy, M., Phillips, A. & Yen, P. (2017). Nursing Informatics Competency Assessment for the Nurse Leader, The Delphi Study. The Journal of Nursing Administration,47(4), 212-218. doi: 10.1097/NNA.0000000000000467
•                                                     Cosansu, G., DeBlieck, C., Eardley, D., Garner, L., Krumwiede, K., Nahcivan, N. & Secginli, S. (2018).  The Omaha System as a Structured Instrument for Bridging Nursing Informatics With Public Health Nursing Education: A Feasibility Study. Computers, Informatics, Nursing, 36(6), 275-283. doi: 10.1097/CIN.0000000000000425
•                                                     Kassam, I., Nagle, L., & Strudwik, G. (2017). Informatics competencies for nurse leaders: protocol for a scoping review. BMJ Open, 7(12), e018855. doi: 10.1136/bmjopen-2017-018855
•                                                     Kelly, J., Spurlock, A. & Vardaman, S. (2017). Patient Safety Addressed Through Reconciliations. Computers, Informatics, Nursing 35(7), 325-328. doi: 10.1097/CIN.000000000000037.1
•                                                     Vottero, B. (2017). Teaching Informatics to Prelicensure, RN-BSN, and Graduate Level Students. Nurse Educator 42(55) S22-S26 doi:10.1097/NNE.0000000000000414
•                                                     Watts, C.S. (2016). Preparing Nursing Graduates for the Future: Adding Informatics Education To Entry Level Programs. Nursing Informatics Today, 31(1), 10-16
•      Wilburn, A. (2018). Nursing Informatics: Ethical Considerations for Adopting Electronic Records. NASN School Nurse, 33(3), 150-153. doi:10.1177/1942602X17712020